Representatives from the health sector have laid bare their frustrations with the Covid-19 response.
Representatives from the health sector have laid bare their frustrations with the Covid-19 response.
Some of those on the health frontline say they are near breaking point as representatives laid bare their frustrations with the response to the Covid-19 crisis before the Epidemic Response Committee.
General practices, which run hand-to-mouth operations, are on their knees while dental surgeries are in crisis due to a lack of funding and an inability to treat people during the lockdown.
Those who care for New Zealanders most vulnerable to Covid-19 - the elderly and the disabled - have battled district health boards for access to personal protective equipment (PPE).
And our contact-tracing issues were because of regional units using antiquated systems, said epidemiologist Sir David Skegg.
Sir David, a professor at the University of Otago, said these issues were the result of our public health system being "run down to an extremely dangerous level over a number of years".
Yet despite all those issues, we could manage an historic and unique victory to eliminate Covid-19, he said.
"If we are successful this will be one of New Zealand's greatest achievements."
Representatives from various sections of the health system appeared before the Epidemic Response Committee to air their frustrations with the response to Covid-19.
Some of the clear issues were a lack of funding, access to PPE, conflicting advice from the Ministry of Health and a concern about the deluge of care waiting on the other side of the lockdown.
NZ Medical Association
Cabinet's move to block a second tranche of funding to GPs have left some practices in dire straits, said Kate Baddock, chair of the NZ Medical Association.
Baddock said that decision needed to be reversed by the end of the week, or practices and doctors would be out of work.
A lot of GPs depended on co-payments and were "hand-to-mouth" so the drop in appointments and some people not being able to afford a consultation meant their cash flow had dried up, said Baddock.
Many were depending on that extra funding to stay afloat.
Prime Minister Jacinda Ardern said this funding was part of an "ongoing conversation".
Baddock also described the roll-out of the flu vaccine which left her own practice without a supply for 10 days despite needing to vaccinate 4,000 vulnerable patients a "debacle".
Ardern later disagreed with this opinion and said they'd started the vaccination programme to ensure at risk people were vaccinated.
""[It was a] total, total disaster," Baddock said.
Aged Care Association
Despite publically being promised a good supply of PPE, aged care facilities were having to agitate DHBs to get stock, said Simon Wallace, chief executive of the Aged Care Association.
The supply issue had improved greatly, but there were still pockets around New Zealand struggling and facilities shouldn't have to "quibble" with health boards, he said.
Wallace also wants mandatory testing of every one of the 700 people who are admitted to a facility on average each week.
As there was clearly capacity within the testing regime, Wallace said he didn't understand why the Ministry of Health wasn't shifting on its position.
Director General of Health Ashley Bloomfield has previously rejected testing every incoming resident but anyone with any symptoms should still be tested.
"If the likelihood is low but the severity is high like it is with Covid 19 why would you not test?," Wallace said.
"We just don't understand the rationale for not testing."
Wallace said three reviews into the aged care sector at the same time only added to facilities' stresses.
DHBs are auditing infection control and procedures, there's a review into the six care homes which have had outbreaks and the Ombudsman is inspecting facilities with detained residents.
Again, the methods varied greatly between DHBs with a manager of a facility in Nelson being brought to tears by how confrontational an auditor was while care homes in Southland were being audited virtually, Wallace said.
"The timing itself is insensitive. We want to work and we want to co-operate but there are huge concerns."
Pharmacy Guild of New Zealand
The $5 prescription co-payment should be axed because it was leaving pharmacies out of pocket and causing people in need to go without, said Andrew Gaudin, chief executive of the Pharmacy Guild of New Zealand.
Many people could no longer afford prescriptions and if conditions went untreated that would mean patients could overwhelm hospitals, Wallace submitted.
Community pharmacies were also struggling under financial burdens caused by Covid-19 and some might close which would be a great detriment to the health system, he submitted.
Disability support workers have struggled with "slow and contradictory" decision-making by the Ministry of Health, said chief executive of the Disability Support Network, Garth Bennie.
For example, disability support workers originally weren't recognised as essential workers and had to fight to get their status changed.
There'd also been "considerable" confusion around guidance on PPE, Bennie said.
Bennie said there'd been contradictions within the Ministry itself and significant delays to get advice approved.
Disability support providers were also having to battle individual DHBs for PPE which had been unaware of the scope and scale of the disability sector.
The PPE situation was "definitely a work in progress" and while it had improved, there were still issues with supply, Bennie said.
Some were having to ration PPE themselves because "they don't feel they have an adequate source" while one provider was yet to receive any, Bennie said.
Bennie said the disability sector had entered the pandemic under already well-documented financial stress and services would suffer as they were stretched further.
The single biggest cost for providers was staff, Bennie said.
Some lost 30 per cent of their workforce during the lockdown because the workers themselves were vulnerable and were told not to apply for the wage subsidy scheme as staff would be provided.
That hasn't yet happened and so providers had to employ workers at their own cost, Bennie said.
There had, however, been a flexibility under the Covid-19 crisis about how staff and resources were deployed which the sector had been asking for "for years", Bennie said.
There's a massive dental care crisis looming after restrictions are lifted, warned Dr Katie Ayers, president of the Dental Association.
One man was already in an intensive care unit after an infection spread from his mouth and down his neck, needing urgent surgery under general anesthetic.
Surgeries were expecting swathes of patients who'd gone without attention under the lockdown, Ayers said.
"People in their desperation are going to resort to the extraction of teeth, which will lead to problems, particularly for children."
Dentists weren't allowed to open under lockdown except for emergencies because of the risk of transmission which came with their work.
And they're yet to find out if they're able to resume under alert level 3 or 3 as they were yet to receive clear guidelines, Ayers said.
The dental sector in Australia had been allowed to work on their own guidelines and there people would be able to get treatment on Monday.
New Zealand dentists needed guidelines within days, Ayers said.
Ayers also submitted they were desperate for more funding and a survey of their members showed more than half would have to go into debt to keep their doors open.
Considerable progress towards elimination
Sir David said New Zealand had made "considerable progress" towards elimination, shown by falling cases, quarantine at the border, testing criteria broadened and done more liberally and the deficiencies of our contact tracing abilities being addressed.
Shifting the goal posts to eliminate Covid-19 rather than just suppress it was "an ambitious decision" by the Government, he said.
"I believe we have a better chance of elimination than any other western country."
He agreed with National health spokesman Michael Woodhouse that the lockdown wouldn't have needed to be extended if contact tracing was where it should be - the gold standard.
Sir David said Australia was also now looking to eliminate the virus and this gave him hope of an "Australasian bubble".
Other countries, like the UK and the United States, had zero chance of elimination.
"I fear that much of the world is going to look like a trainwreck in slow motion."
Sir David said in order to achieve that, there must be timely identification of cases, rapid contact tracing and isolation of contacts.
But perhaps the most important measure would be New Zealanders continuing to physically distance from others and keep their bubbles tight, he said.
New Zealand had also been able to achieve a lot despite the public health sector being "neglected in recent decades by both Labour and National-led governments" Sir David said.
There were very few countries in the world where the capacity of central government for public health surveillance and action was so weak, he said.
New Zealand's issues with contact tracing were because of "antequated tracing systems which cannot link data between regional public health units and the central contact tracing service", Sir David said.
Opposition leader Simon Bridges asked whether Australia was in a better position to test and contact trace because they'd geared up their health system more quickly.
Sir David replied they were only able to do that because their health sector was much healthier than ours to begin with.
"The specific problem I'm talking about is public health - the preventative side - has been run down to an extremely dangerous level over a number of years."
Bridges said decades of issues wouldn't be solved by Monday at midnight, when the lockdown is set to lift.
"No," Sir David agreed.
"But I think our health authorities have done a remarkable job in getting us to the position we're in, which by world standards is exceptionally good given the lack of staff, personnel and expertise that was there."
